title: Recurrent events following patent foramen ovale closure in patients above 55 years of age with presumed paradoxical embolism.
abstract: OBJECTIVE
  The aim of this article is to summarize our experience of patent foramen ovale (PFO) closure in patients above the age of 55 years.
  
  
  BACKGROUND
  PFO is associated with cryptogenic thromboembolic events (TEs) in patients younger than 55 years. Little is known about the recurrence rate of TE in patients above the age of 55 years undergoing PFO closure for presumed paradoxical embolism.
  
  
  METHODS
  PFO closure was performed in 1,055 patients, 423 of whom were above 55 years of age. Implantation of the device was guided by fluoroscopy and transesophageal or intracardiac echocardiography.
  
  
  RESULTS
  A PFO occluding device was implanted successfully in all patients. Residual shunt was documented in 10% of patients above 55 years of age and in 8.4% of patients aged 55 years or younger (P = 0.325). During a median follow-up period of 18 months (range, 0-162 months) the annual incidence of recurrent TE in patients above 55 years was 1.8% while patients aged 55 or below had an annual incidence of recurrent TE of 1.3%. TE-free survival was similar in patients above 55 years of age compared with those aged 55 years and below.
  
  
  CONCLUSIONS
  PFO closure in older patients is as efficient and seems comparable to those under the age of 55. Although traditional cardiovascular risk factors may be more frequent in the older age group compared with those younger than 55 years, PFO closure should not be withheld as a possible therapeutic option in this age group.
authors.affiliation: Section of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Spies
authors.forename: Abha
authors.initials: A
authors.lastname: Khandelwal
authors.forename: Ines
authors.initials: I
authors.lastname: Timmemanns
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Kavinsky
authors.forename: Rainer
authors.initials: R
authors.lastname: Schräder
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation; D018572:Disease-Free Survival; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D004867:Equipment Design; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult